Experts have long feared the eventual arrival of a completely drug-resistant TB (tuberculosis) - a hospital in India has reported the nation's first cases of a type of tuberculosis for which there are no effective drugs, making the TB virtually untreatable. Other untreatable TBs have emerged over the last nine years; there have been reported cases in Iran and Italy. Most likely, there are many more cases that have never been documented, experts believe.
TB, unlike the flu, does not spread so easily from person-to-person. The majority of virulent TB cases have not occurred through transmission, but rather as a result of a bacterium mutating while already in an infected person, usually a poorly treated individual.
WHO (World Health Organization) has not so far used the term 'untreatable' for TB, and instead classes the more resistant forms as XDR (extensively drug resistant).
Doctors in India have tried using over a dozen different medications without any success. Dr. Kenneth Castro, CDC TB Elimination Division (USA), said about this latest reported case:
"It is concerning. Anytime we see something like this, we better get on top of it before it becomes a more widespread problem."
In typical cases, TB is effectively treated with a six-to-nine month course of antibiotics. However, if treatment is not completed the bacterium may mutate into a more virulent strain; one that resists current medications. The more it mutates, the harder it becomes to treat properly.
In Mumbai over the last three years, hospitals have reported 12 cases of patients with resistant TB - initial antibiotic treatments were ineffective, as were subsequent ones. Of those twelve, three have ended in death, and none of the remaining 8 have been treated effectively.
Doctors from P.D. Hinduja National Hospital and Medical Research Center, Mumbai, India, wrote in Clinical Infectious Diseases that in four cases patients were administered wrong drugs, which allowed the bacteria to mutate and become more resistant in three of them. They are said to have received "erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners."
The remaining nine patients, all of whom come from slum areas of the city, have a poor prognosis, the doctors added. One of them has passed on the virulent strain to one of her daughters. One of the patients is also HIV positive. TB death rates are much higher among HIV positive patients.
Many patients in India turn to private doctors to treat TB, probably due to India's testing and treatment methods, many experts claim. The problem is that a considerable proportion of private doctors do not know how to properly treat TB and have not been kept up-to-date on TB's drug resistance problem. In private practice, patients are commonly prescribed the wrong medications.
If drug-resistant TB spreads, there is a risk that we may be going back to over 100 years ago when the only defense against the bacterium was people's immune system, rather than medical treatment.
Written by Christian Nordqvist